Provider Demographics
NPI:1518353515
Name:ARCH CREEK SENIOR CARE SERVICES INCORPORATED
Entity Type:Organization
Organization Name:ARCH CREEK SENIOR CARE SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:LANNETTE
Authorized Official - Last Name:STURRUP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:786-916-0661
Mailing Address - Street 1:1810 NE 153RD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-6004
Mailing Address - Country:US
Mailing Address - Phone:305-944-0663
Mailing Address - Fax:305-944-0662
Practice Address - Street 1:1810 NE 153RD ST STE 3
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-6004
Practice Address - Country:US
Practice Address - Phone:305-944-0663
Practice Address - Fax:305-944-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994365251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102772100Medicaid